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What is a group code in medical billing?

Group Codes assign financial responsibility for the unpaid portion of the claim balance e.g., CO (Contractual Obligation) assigns responsibility to the provider and PR (Patient Responsibility) assigns responsibility to the patient. Medicare beneficiaries may be billed only when Group Code PR is used with an adjustment.

What are group codes in medical billing?

Each year in the U.S., health care insurers process over 5 billion claims for payment. Standardized coding systems are essential so Medicare and other health insurance programs can process claims in an orderly and consistent manner. HCPCS is divided into 2 main subsystems Level I and Level II.

What are the EOB group codes?

The five EOB Claim Adjustment Group Codes are Contractual Obligation (CO), Corrections and Reversal (CR), Other Adjustment (OA), Payer Initiated Reductions (PI), and Patient Responsibility (PR).

What are claim adjustment group codes?

A Claim Adjustment Group Code consists of two alpha characters that assign the responsibility of a Claim Adjustment on the insurance Explanation of Benefits. These Group Codes are combined with Claim Adjustment Reason Codes that can be numeric or alpha-numeric, ranging from 1 to W2.

What is a group code for insurance?

Like your individual policy number, the group number on your insurance card is a code assigned to your employers insurance plan. Your insurance group numbers help insurance companies identify the benefits included in your employers plan and process claims effectively.